10/03/2025
Food allergies represent a significant and escalating global health burden, with clinical manifestations ranging from mild reactions to severe, life-threatening anaphylaxis. Factors such as harmful environmental exposures, poor dietary choices, and gut microbiota dysregulation are increasingly recognized beyond genetic predisposition as contributors to the development of allergies and disease severity. In individuals with food allergies, processed food intake should be particularly avoided as it may contain traces of allergens and cell toxic additives. Dietary exposures can influence immune regulation, gut microbiota composition, and the risk of severe allergic events such as anaphylaxis. Potential approaches for the treatment and management of allergies under investigation include specific immunotherapy, biologics targeting key immune pathways, microbiome-modulating strategies, and dietary interventions.
This issue opens with an editorial by Kuehn and Eiwegger highlighting the central role of gut-associated immunity in oral immunotherapy for peanut allergy. Steinberg and Goebel et al.evaluate the risks and potential benefits of premastication, by focusing on its possible implications in food allergy prevention and oral tolerance development. Rosser et al. conduct a systematic review and meta-analysis to evaluate the impact of oral immunotherapy on food allergy-related quality of life. Zhang et al. characterize relationships between the oral and gut microbiomes and systemic processes associated with reaction threshold in peanut allergy. Wai, Leung N.Y.H. and Leung A.S.Y. construct a fish allergenicity ladder and identify fish parvalbumin epitopes to improve the diagnosis of fish allergy. Clement et al. demonstrate that regulatory B cells are present in the circulation of patients with eosinophilic esophagitis milk allergy and in the esophageal tissue of mice exposed to an acute, food antigen-driven model of the disease. Höfer et al. identify phenotype-specific features of tree nut-induced anaphylaxis, including age distribution, symptom profile, reaction severity, potential cofactors, and comorbidities, and analyze temporal trends and regional patterns using data from the European Anaphylaxis Registry. Braskett and Goleva et al. perform a lipidomic analysis of esophageal epithelium, revealing a distinctive sphingolipid profile in eosinophilic esophagitis. Bartha, Boyd, Foong, Krawiec, Marques-Mejias, Marshall and Radulovic et al. determine the diagnostic accuracy of basophil activation test in the diagnosis of baked milk and fresh milk allergies, and compare it with the diagnostic accuracy of tests currently used in clinical practice, such as the skin prick test and sIgE. Gonzalez-Delgado et al. identify potential biomarkers implicated in the pathophysiology of adult-onset food protein-induced enterocolitis syndrome. Akagawa et al. investigate whether gut dysbiosis at the time of diagnosis in children with hen’s egg allergy can predict tolerance acquisition within two years of treatment. Umezawa et al. highlight distinct metabolic pathways associated with IgE-mediated food allergy and food protein-induced enterocolitis syndrome, with urinary prostaglandin metabolites showing potential as biomarkers for clinical differentiation. Kamphuis and Loste et al. demonstrate that aging increases the severity of both FcεRI- and MrgprB2-mediated anaphylaxis in mice. Karnaneedi et al. examine species-specific IgE-binding patterns in shrimp-allergic individuals from Australia and the United States to improve the diagnostic accuracy and treatment. Röntynen et al. investigate the natural resolution of confirmed cashew allergy and predictors for recovery. Zhao et al. demonstrate that daily intake of monosodium glutamate, disodium guanylate, disodium inosinate, and their combination disrupts the epithelial barrier integrity and induces multiple harmful biological processes, including oxidative stress, unfolded protein response, and mitochondrial dysfunction, as well as alterations in key molecular pathways regulating autophagy and protein homeostasis in intestinal epithelial cells. Corcoran et al. show that higher baseline specific IgE level to cow's milk protein at the time of diagnosis is associated with incomplete tolerance to cow's milk protein at 12 months. Devotta et al. report that living with older siblings shapes the infant gut microbiome and metabolic pathways, correlating with reduced food allergen sensitization and enhanced immune regulation. Watanabe et al. suggest that food allergy-specific instruments provide more sensitive and specific insights into the lived experiences of adult patients with food protein-induced enterocolitis syndrome than generic health-related quality of life tools.
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